Characteristics and Causes of A.D.D./A.D.H.D.
Grant L. Martin, Ph.D.

Attention disorders may be one of the most prevalent problems of childhood. Three to five percent of the child population (roughly 2 million school-aged children) has some type of attention disorder—or one attention disorder child per classroom. What’s going on?

While professional debate continues on the exact characteristics of attention disorders, clinical research strongly suggests that people suffering from inattention fall into two categories—those who are hyperactive and those who are not. Attention Deficit Hyperactivity Disorder (ADHD) consists of motor hyperactivity and impulsive behavior, while Attention Deficit Disorder (ADD) is characterized by inattention, disorganization and difficulty in completing tasks.

ADHD children behave in an impulsive and aggressive way. They often seem guiltless, are unpopular and perform poorly in school. They have little self-control and are very impulsive, noisy, disruptive, messy, irresponsible and immature for their age. If the image of “Dennis the Menace” comes to mind, you’ve got the picture.

In contrast, ADD children tend to be anxious, shy, socially withdrawn and somewhat unpopular. They tend to perform poorly in sports and in school, and often daydream and stare into space. They forget daily activities and are sluggish and drowsy. Terms like “space cadet” and “couch potato” fit well. But they are less aggressive, impulsive and hyperactive than ADHD children and have fewer relational problems, as well.

While all children on occasion will be impulsive or “hyper,” kids with attention disorders exhibit these characteristics all the time. They “misbehave” everywhere—school, church, grandma’s, the grocery store and home.

Diagnosing attention deficit disorders can be tricky. There is a big difference between suspecting a child has an attention problem and knowing for sure that the child has ADHD or ADD. Proper diagnosis and treatment by a competent professional is important for the long-term well-being of your child and your family. The following information is provided to help you determine whether you should seek professional help or if your child is merely tightly-wound and squirmy. For the sake of ease, the abbreviation ADD will be used for all types of attention disorders, unless a specific reference is being made.

Characteristics of ADD

Most experts agree that four characteristics or tendencies identify attention deficit disorders.

• Inattention and distractibility. An ADD child has a difficult time focusing on the task at hand and sticking to it—he usually ends up daydreaming. He cannot concentrate on schoolwork or anything that requires sustained attention. Following through on instruction and completing a task is almost an impossibility, especially if the instructions involve multiple steps; and he gives the impression of not listening. But even more frustrating for the parent or teacher is this child’s ability to pay attention in certain circumstances, like when watching TV or playing video games. He may also shape up while at the doctor’s office or one-on-one with an adult. This adds to the problem. When parents and teachers see the child paying attention in one situation, they tend to conclude that he simply does not try in others, like when asked to do chores or follow instructions. The heart of understanding attention disorders is determining how much of the attentional choosing is conscious, and how much is biochemically determined. The problem is regulation of focus and attention.
  
• Overarousal or hyperactivity. Some ADD children are excessively restless, overactive and easily aroused. This affects their emotions and body movement. It is important to remember that while hyperactivity used to be the primary description in attention disorders, it actually occurs in less than 30 percent of children who have ADD. (Sometimes hyperactivity is used to refer to the entire syndrome of attention disorders. Other times the term only describes overarousal. Keep these different uses in mind as you read various books and articles about ADD.) Hyperactive children have a tough time controlling their body movement, especially when they are required to sit still for a long time. This ranges from minor fidgeting to perpetual motion. Some hyperactive children also have restless sleep patterns. These kids are rarely focused—they will move from one thing to the next with little purpose. While a trip to the grocery store might be a mild adventure, a stop at the toy store can turn into an absolute disaster. Emotional variation also comes into play. An ADD child’s emotions fluctuate quickly, going from one extreme to the other. Whether they are happy or sad, the child’s feelings are expressed for everyone to notice. He may become very frustrated over a minor incident. But chances are he will forget the upsetting event just as quickly. This can be frustrating to a parent who is still bothered by the outburst and doesn’t understand why the child is no longer upset. This leads to the assumption that ADD children lack a conscience. But that’s untrue—they’ve just moved on to other thoughts and have put the outburst behind them.
  
• Impulsivity. ADD children appear not to think before they act and have trouble weighing the consequences of their choices. They just can’t seem to wait—everything has to happen NOW. In young children, this may result in injury—an ADD child often literally leaps before he looks. He may jump off the back of the couch because it looks like fun, but not have the coordination to land safely. He may also fight frequently with his friends because of impulsive words and actions. He wants to be in charge socially because his dominance will prevent him from being bored; but his peers often find his aggressiveness irritating. In school, ADD children constantly interrupt the teacher, jumping up to answer a question before it is even asked. They tend to work impulsively, jotting down answers without thinking through the problems or thoroughly reading questions. You can often reason one-on-one with these children, with them logically analyzing the consequences of their actions. But put them back in the real world and they seem overwhelmed, resuming to act first and think later. ADD children have a lot of trouble following rules. They may know the rules and even be able to explain them. But 10 minutes later, when a parent or teacher isn’t looking, they are “at it” again. Their need for immediate gratification, coupled with the inability to stop and think, leads to impetuous non-thinking behavior. And from all appearances, these children just don’t seem to “get it.” Thus, they are often labeled willfully disobedient, inconsiderate and oppositional. Attention deficit disorder is not a problem of knowing what to do, it is a problem of not doing what the child knows.*
  
• Difficulty with rewards. ADD children have problems working toward a long-term goal. They often want brief, repeated payoffs rather than a single, delayed reward. They want what they want right away, and even with repeated rewards, they do not respond to incentives as well as other children their age. And once the reward system is removed, the ADD child is likely to regress. Punishment also seems to have a limited effect on the child’s behavior. A scolding will usually work on the child’s behavior for only a few minutes before the misbehavior continues.
  
• Difficulty with social skills. Many ADD children and teens misread social cues.
  This can affect the development of healthy interpersonal skills, leading to frustration and inappropriate or withdrawn behavior.

Causes and sources of ADD

Although ADD continues to be one of the most thoroughly researched conditions of childhood, its exact causes are still not known. The neurochemical abnormalities that might underlie this disorder are difficult to document though research suggests that ADD has a biological basis. Many ADD children seem to arrive in the world with temperaments that leave them difficult to manage. Part of this predisposition may very well be inherited—very often kids are described as “a chip off the old block.”

But take heart. The symptoms of ADD are not externally created by parents. A child’s attentional problems do not result from faulty discipline. While it is true that parental frustration and negative reactions toward your child can aggravate the problem, guilt, anger and resentment can hurt a parent’s relationship with his child and hinder effective treatment. A nurturing home with clear and consistent structure is crucial to the treatment of ADD children. And while environmental conditions can play a role, the effects of changes in diet and other similar things show up more on an individual basis than in large numbers. There is very little evidence that ADD arises purely out of social or environmental factors, like dysfunctional families, vitamin deficiency, excessive amounts of sugar, lead poisoning, fluorescent lighting or faulty parenting.

Does my child suffer from ADD?

There is no simple test that determines a child has ADD. Diagnosis is a complicated process that requires the skill of a psychologist, psychiatrist, pediatrician or pediatric neurologist. A proper diagnosis orients the child and his parents or caregivers to the nature of his difficulties by providing information about his strengths and weaknesses, and any situations that would be particularly troublesome for him. It should also reveal his academic abilities, enabling him to get the most out of school.

Perhaps even more important, it is crucial to determine the presence of other problems—learning disabilities, mood disorder, anxiety disorder, conduct disorder, poor socialization, disruptive family relationships—and the evaluation will do this, as well. Treatment can then be appropriately provided for all of the child’s concerns.

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